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Date: Thursday, August 21, 1997
FOR IMMEDIATE RELEASE
Contact: HCFA Press Office (202) 690-6145, AoA Press Office (202) 401-4541

The Clinton Administration today awarded more than $2.25 million in grants for new programs to complement Medicare's ongoing anti-fraud efforts.

The grants are funded by a special account created by the Health Insurance Portability and Accountability Act (HIPAA), signed into law last August by President Clinton. Today's announcement comes on the one-year anniversary of this groundbreaking legislation, which, for the first time, created a stable source of funding for fraud control activities.

Among the grants announced today are "Health Care Fraud and Abuse Control Grants" totaling more than $1.5 million which will be administered by the Department of Health and Human Services' Health Care Financing Administration (HCFA), the HHS Inspector General and the Department of Justice (DoJ). The grants are being distributed to nine state agencies, the District of Columbia, the Department of Defense, and the Internal Revenue Service. They will cover the cost of audits, inspections, equipment, provider evaluations, investigations, prosecutions and consumer education.

HHS' Administration on Aging (AoA) also announced an additional 15 anti-fraud grants totaling $750,000, which will be administered through state offices on aging. The grants will help expand the department's highly successful "Operation Restore Trust" health care anti-waste, fraud, and abuse program, launched in 1995 as a five-state pilot project. Currently, Operation Restore Trust is identifying $23 in waste, fraud, and abuse for every $1 invested, and is being expanded to 12 new states.

"These grants will bring new tools and new people into the front lines of our fight against health care fraud and abuse," said HHS Secretary Donna E. Shalala. "The fight against Medicare fraud and abuse is a joint effort. It requires federal, state and local officials working together. We must continue to identify existing problems, take action against those who violate the law, and work with Congress to close loopholes and stiffen laws and penalties."

"Money spent to fight fraud and abuse is money well spent, as our ongoing anti-frauds efforts clearly show that returns far exceed expenditures," said Bruce C. Vladeck, Administrator of the Health Care Financing Administration which runs Medicare. Besides Operation Restore Trust's 23-to-1 return, the Medicare Integrity program is saving $14 for every $1 spent by making sure Medicare payments are appropriate, noted Vladeck.

"These projects represent a significant expansion of our ongoing battle against waste, fraud and abuse, and they make the most of our vast network of state and tribal agencies, ombudsman programs, and community-based service providers," said Acting Principal Deputy Assistant Secretary for Aging William F. Benson. "It is these people on the front lines who are key to stopping fraud and abuse in its tracks."

The Health Insurance Portability and Accountability Act (HIPAA) established the Health Care Fraud and Abuse Control Account, a key proposal of the Clinton Administration, to which money is deposited annually from the Medicare Part A Trust Fund to help finance expanded fraud and abuse control activities. The additional funding, $104 million in FY 1997 and nearly $120 million in FY 1998, will fund the activities of the HHS Inspector General, the Department of Justice and others to coordinate federal, state and local health care law enforcement programs; conduct investigations, audits, evaluations and inspections relating to the delivery and payment of health care; help facilitate enforcement of civil, criminal and administrative statutes on health care fraud and abuse; provide guidance to the health care industry on fraudulent health care practices; and establish a national data bank to receive and report final adverse actions against health care providers.

"These grants are another clear warning to dishonest health care providers that, under the Clinton Administration, government agencies are cooperating as never before to eliminate fraud and abuse," said Inspector General June Gibbs Brown.

The Health Care Fraud and Abuse Control Program grants announced today are awarded to:

• California and New York Offices of Attorneys General: $300,000 These states are sharing this grant and together will develop an automated system for managing health care fraud investigations and prosecutions. California's case management system software will serve as a starting point and be adapted for "beginning to end" oversight of all activities involved in complaint registration, investigation, audit, and prosecution.
• Alabama Office of Attorney General: $232,700 The grant will help train investigators to do computer search and seizures and use other modern techniques for health care fraud prosecution, replace obsolete equipment in the Medicaid Fraud Control Unit, and conduct an outside review of fraud and abuse controls in the state's new Medicaid hospital reimbursement system.
• Colorado Department of Health Care Policy: $213,334 The grant will be used to look for loopholes that foster fraud and abuse where health care programs overlap, and to see if new or more stringent rules could close these loopholes. It also will be used to learn how to validate patient diagnoses in order to prevent abuse of a new system in which managed care payments are adjusted for the health status of their members.
• Nebraska Department of Insurance: $100,000 The grant will help purchase a computerized relational data base, the equipment necessary to operate it, and related training in its use.
• North Carolina Department of Insurance: $28,932 The funds will be used to contract with medical professionals, statisticians and electronic data processing personnel to help investigators detect fraud, obtain convictions, and recover funds. They also will help develop methods to prevent fraud and abuse.
• Pennsylvania Department of Public Welfare: $112,315 The grant will buy new software to reduce the evaluation and preparation time for fraud and abuse cases by two to three weeks. The grant also will provide funds to purchase upgraded computer equipment.
• Tennessee Department of Commerce & Insurance: $121,700 The grant will be used to improve and coordinate actions among the public, private industry and law enforcement agencies. Investigators will be trained to detect workers compensation and health care plan frauds. Consumer insurance complaint investigators will be taught to recognize fraud and abuse. And the public will learn ways in which to recognize fraud and abuse.
• Wisconsin Office of Attorney General: $58,988 The Senior Sleuth Project will utilize the talents of senior citizen volunteers to catch health care fraud "artists" preying on the elderly with Internet health care scams. The grant money will provide a full-time investigator, training materials and computer equipment.
• District of Columbia Department of Health and Medical Assistance: $83,776 The grant will help purchase computer software to reduce fraudulent billing for health-related transportation services, develop electronic communications between the District's Government Fraud Investigative Unit and the Medical Assistance Administration, and provide services and training for fraud and abuse detection.
• Internal Revenue Service: $107,000 The funds will bolster Criminal Investigation unit health care fraud investigations. A Health Care Fraud Training Seminar and a special seminar on managed care fraud will be conducted.
• Department of Defense Inspector General: $195,612 The Defense Criminal Investigative Service will purchase computer hardware and software to establish 12 additional on-line sites for direct access, downloading and analysis of data from the Office of the Civilian Health and Medical Program of the Uniformed Services' Care Detail Information System.

• Arizona Aging and Adult Administration, Phoenix, Ariz. - $50,000 The project will train retired professionals to identify and refer cases of fraud, waste and abuse. It will implement a system to ensure tracking of referrals and will produce a comprehensive training manual, as well as a guide for obtaining and utilizing volunteer resources and videos.
• California Department of Aging, Sacramento, Calif. - $50,000 The project will enhance fraud tracking systems. Activities will include a report-generating software mechanism, a number of educational brochures and feature articles, and advanced curriculum training sessions designed to educate the aging network, consumers, and families to identify and report instances of health care waste, fraud and abuse.
• Colorado Division of Aging and Adult Services, Denver, Colo. - $50,000 The project will train professionals, para-professionals, volunteers and consumers to empower older persons to detect and act on suspected waste, fraud and abuse.
• Florida Department of Elder Affairs, Tallahassee, Fla. - $50,000 The project will target Medicare/Medicaid/insurance fraud, waste and abuse outreach and education to disabled and minority beneficiaries and their families.
• Georgia Division on Aging Services, Atlanta, Ga. - $50,000 The project will educate providers in the aging network, older Georgians, and their families and caregivers about health care fraud, waste and abuse.
• Illinois Department on Aging, Springfield, Ill. - $50,000 The project will distribute materials at nursing home pre-screenings and in-home care assessments, develop a response system to track referrals, and train nursing home ombudsmen and National Senior Service Corporation volunteers.
• Massachusetts Executive Office of Elderly Affairs, Boston Mass. - $50,000 The project will teach Medicare and Medicaid beneficiaries what is included under their health coverage, and how to identify and report possible fraud and abuse.
• Missouri Division of Aging, Jefferson City, Mo. - $50,000 The project will establish a statewide committee to develop training materials, engage in outreach and education activities, outline a media campaign, and develop speaker's bureau packets.
• New York State Office for the Aging, Albany, N.Y. - $50,000 The project will develop a computerized, trainee-friendly curriculum to train professionals and the general public, expand outreach efforts to underserved regions and senior center public forums, strengthen statewide efficiencies in detecting and reporting fraud, waste and abuse, and establish evaluation measurement tools.
• Ohio Department of Aging, Columbus, Ohio - $50,000 The project will educate certified providers and suppliers about appropriate and lawful billing and service provision practices, establish a system of reporting and tracking that is easily accessible and understandable to consumers, convene citizen summits, develop training manuals and outreach materials, and establish tracking protocols.
• Pennsylvania Department of Aging, Harrisburg, Pa. - $50,000 The project will educate older people about fraudulent practices, develop local and regional planning groups, establish local reporting systems in cooperation with state and federal agencies, encourage self-monitoring and reporting by provider companies and educate provider employees about reporting procedures.
• Tennessee Commission on Aging, Nashville, Tenn. - $50,000 The project will provide consumer-directed informational materials and train-the-trainer sessions which are specifically targeted to advocates working with older clients and their families. These activities will then be delivered through a state network of over 150 senior citizen centers and fifty AARP chapters.
• Texas Department on Aging, Austin, Texas - $50,000 The project will initiate a state-wide education/awareness project to educate older persons, their families, caregivers, and aging network providers. Products will include a training curriculum and informational resources, additional trained volunteers at the regional/community level, public service announcements and a complaint and referral process.
• Virginia Department for the Aging, Richmond, Va. - $50,000 The project will establish a statewide beneficiary outreach council, conduct train-the-trainer sessions targeted toward volunteers in the insurance counseling and ombudsman programs, conduct regional education workshops for older Virginians and their families and develop educational materials.
• Washington Aging and Adult Services Administration, Olympia, Wash. - $50,000 The project will establish a state level coalition to design a training curriculum, brochure, and media materials and strengthen coordination between state and federal agencies responsible for investigating health care fraud. Identification and reporting methods will be incorporated into training materials, orientations, survey tools, publications and resource guides.
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